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Purpose: Thoracoscopic OA/TOF repair was first described in 1999. Currently, less than 10% of surgeons routinely employ minimally access surgery. Our primary aim was to review our immediate-, early- and long-term outcomes with this technique compared with the open approach. Methods: A retrospective review of all patients undergoing primary OA/TOF (Type C) repair at our institution from 2009 was conducted. Outcome measures included length of surgery, conversion rate from thoracoscopy, early complications such as anastomotic leak and post-operative complications such as anastomotic strictures needing dilatations. Fisher's exact and Kruskal–Wallis tests were used for statistical analysis. Results: 95 patients in total underwent OA/TOF repair during the study period of which 61 (64%) were completed via an open approach. 34 were attempted thoracoscopically of which 11 (33%) were converted. There was only one clinically significant anastomotic leak in our series that took place in the thoracoscopic group. We identified a significantly higher stricture rate in our thoracoscopic cohort (72%) versus open surgery (43%, P < 0.05). However, the median number of dilations (3) performed was not significantly different between the groups. There was one recurrent fistula in the thoracoscopic converted to open group. Our median follow-up was 60 months across the groups. Conclusion: In our experience, the clinically significant leak rate for both open and thoracoscopic repair as well as recurrent fistula is much lower than has been reported in the literature. We do not routinely perform contrast studies and are, thus, reporting clinically significant leaks only. The use of post-operative neck flexion, ventilation and paralysis is likely to be protective towards a leak. Thoracoscopic OA/TOF repair is associated with a higher stricture rate compared with open surgery; however, these strictures respond to a similar number of dilatations and are no more refractory. Larger, multicentre studies may be useful to investigate these finding further. [ABSTRACT FROM AUTHOR]

Decision aids (DAs) are evidence-based tools that support shared decision-making (SDM) implementation in practice; this study aimed to identify existing osteoporosis DAs and assess their quality and efficacy; and to gain feedback from a patient advisory group on findings and implications for further research. We searched multiple bibliographic databases to identify research studies from 2000 to 2019 and undertook an environmental scan (search conducted February 2019, repeated in March 2020). A pair of reviewers, working independently selected studies for inclusion, extracted data, evaluated each trial's risk of bias, and conducted DA quality assessment using the International Patient Decision Aid Standards (IPDAS). Public contributors (patients and caregivers with experience of osteoporosis and fragility fractures) participated in discussion groups to review a sample of DAs, express preferences for a new DA, and discuss plans for development of a new DA. We identified 6 studies, with high or unclear risk of bias. Across included studies, use of an osteoporosis DA was reported to result in reduced decisional conflict compared with baseline, increased SDM, and increased accuracy of patients' perceived fracture risk compared with controls. Eleven DAs were identified, of which none met the full set of IPDAS criteria for certification for minimization of bias. Public contributors expressed preferences for encounter DAs that are individualized to patients' own needs and risk. Using a systematic review and environmental scan, we identified 11 decision aids to inform patient decisions about osteoporosis treatment and 6 studies evaluating their effectiveness. Use of decision aids increased accuracy of risk perception and shared decision-making but the decision aids themselves fail to comprehensively meet international quality standards and patient needs, underpinning the need for new DA development. [ABSTRACT FROM AUTHOR]

Objective: There are limited data on therapy selection and switching in psoriatic arthritis (PsA). This 18 country, real-world study assessed use and switching of immunomodulatory therapy (biologic/apremilast), the extent of treatment failure and its association with reduced physical functioning, health-related quality of life (HRQoL), and work productivity and activity impairment (WPAI). Methods: PsA patients under routine care and their treating physicians provided demographics, current therapy, reasons for switching, duration of first therapy, HRQoL, HAQ-DI, and WPAI. Current immunomodulatory therapy was determined as "failing" if, after ≥ 3 months, physician-rated disease severity had worsened, remained severe, was "unstable/deteriorating," or they were dissatisfied with disease control and/or did not consider treatment a "success." Results: Included were 3714 PsA patients; 1455 (40.6%) had never received immunomodulatory therapy; 1796 (50.1%) had ever received 1 immunomodulatory therapy and 331 (9.2%) ≥ 1. Lack of efficacy with first immunomodulatory therapy was the most common reason for switching; patients whose physicians indicated "primary lack of efficacy" as the reason, switched after a mean of 9.4 months. Patients currently failing immunomodulator therapies (n = 246) had poorer HRQoL compared with treatment success (n = 1472) measured by EQ-5D-3L (0.60 vs 0.77%; P < 0.0001); SF-36 PCS (40.8% vs 46.1%; P < 0.0001) MCS (41.1% vs 45.3%; P < 0.0001). Physical functioning, activity, and work productivity were also more impaired (HAQ-DI: 0.88 vs 0.56; activity impairment: 46.7% vs 29.7%; overall work impairment: 35.4% vs 26.1%; all P < 0.0001). Conclusions: Poor treatment response in PsA is associated with substantial negative patient impact. In cases of primary treatment failure, timely switching is needed. [ABSTRACT FROM AUTHOR]

Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict operative difficulty and success. This systematic review assessed whether different definitions of LOD are used in the literature. The PubMed database was searched for articles reporting large hernia repairs that explicitly described LOD. Two reviewers screened citations and extracted data from selected articles, focusing on the definitions used for LOD, study demographics, study design, and reporting surgical specialty. One hundred and seven articles were identified, 93 full-texts examined, and 77 were included in the systematic review. Sixty-seven articles were from the primary literature, and 10 articles were from the secondary literature. Twenty-eight articles (36%) gave a written definition for loss of domain. These varied and divided into six broad groupings; four described the loss of the right of domain, six described abdominal strap muscle contraction, five described the "second abdomen", five describing large irreducible hernias. Six gave miscellaneous definitions. Two articles gave multiple definitions. Twenty articles (26%) gave volumetric definitions; eight used the Tanaka method [hernia sac volume (HSV)/abdominal cavity volume] and five used the Sabbagh method [(HSV)/total peritoneal volume]. The definitions used for loss of domain were not dependent on the reporting specialty. Our systematic review revealed that multiple definitions of loss of domain are being used. These vary and are not interchangeable. Expert consensus on this matter is necessary to standardise this important concept for hernia surgeons. [ABSTRACT FROM AUTHOR]

Aim Of the Study: Complex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years.Methods: We retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary.Main Results: 14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations.Conclusions: MDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic appendicectomy is increasingly used in children. This national retrospective study compared outcomes of paediatric open and laparoscopic appendicectomy.Methods: Length of stay, readmission rates and mortality in children undergoing open and laparoscopic appendicectomy in English NHS Trusts between 1 April 1996 and 31 March 2006 were compared. Procedures coded as emergency excision of appendix (OPCS-4 H01) on the Hospital Episode Statistics (HES) database in patients less than 15 years of age were included. Multivariate analysis was used to identify independent predictors of length of hospital stay and mortality.Results: Eighty-nine thousand, four-hundred and ninety-seven (89,497) appendicectomies were studied; of which, 2,689 (3%) were performed laparoscopically. The percentage of laparoscopic cases rose from 0.6 to 8.4% between 1996 and 2006 (Pearson's r = 0.954, P < 0.001). Length of stay (median 3, interquartile range 2 days, P = 0.068) and 28-day readmission rates were similar (6.3 vs. 7.2%, respectively; P = 0.072) between groups. No independent hospital stay advantage for laparoscopy was observed (P = 0.121). No difference in 30-day mortality (P = 0.986) or 365-day mortality (P = 0.598) was demonstrated.Conclusion: Hospital stay, readmission rates and mortality are similar following laparoscopic and open appendicectomy in children. [ABSTRACT FROM AUTHOR]

Background Outcome data for surgery in paediatric Crohn's disease are limited. We report 10 years' experience at a regional paediatric gastroenterology centre. Methods Children undergoing surgery for Crohn's disease ( January 2002-December 2012) were identified from an onsite patient register. Patients were followed until transition to adult services. Data were obtained from medical records and are expressed as median (range). Results: Sixty-nine children, aged 13.8 years (6.3-17.0) at diagnosis, were included. 42 were male (61%). Followup was 1.8 years (27 days-6 years). Surgery followed diagnosis by 9 months (0 days-7 years). 52 children (75%) received thiopurines and 5 (7%) anti-TNF (tumour necrosis factor) therapy preoperatively. 58 (84%) underwent intra-abdominal surgery (40 right hemicolectomy, 8 stoma formation, 2 subtotal colectomy, 2 small bowel resection, 6 other) and 10 (14%) underwent surgery for perianal disease. The commonest indications for intra-abdominal surgery were stricturing disease 35 (60%) and unresponsive luminal disease 13 (22%). There were 13 (22%) early, and 5 (8.6%) late, complications following intra-abdominal surgery. Nine children had disease relapse, five required further surgery. Height SD scores (SDS) did not increase between diagnosis; -0.5 (-3.4-2.1) and most recent follow up; -0.4 (-3.0-1.1). Body Mass Index (BMI) SDS increased from -1.0 (-6.3-1.5) to -0.3 (-3.3-2.0) ( p<0.05). Conclusions: Surgery was associated with a 22% early complication rate and a 15% risk of relapse. 21% of patients required a second unplanned intra-abdominal procedure. Surgical intervention was associated with an increase in BMI SDS, but not in height SDS. [ABSTRACT FROM AUTHOR]

Background: Appendectomy is one of the most common emergency operations performed in the pediatric population. The aim of this pooled analysis is to compare the outcome from complicated appendicitis (CA) and uncomplicated appendicitis (UA) following laparoscopic appendectomy (LA) and open appendectomy (OA) in children.Methods: A systematic literature search was performed. Primary outcome measures were incidence of complications, intra-abdominal abscess, and wound infection. Secondary outcomes were length of operation, length of hospital stay, incidence of bowel obstruction, and readmission.Results: Seventy-three thousand one hundred fifty appendectomies for UA and 34,474 appendectomies for CA were included. For UA, the only significant difference between the groups was a reduced length of hospital stay following LA. LA in CA was associated with reduced complications (pooled odds ratio [POR] = 0.53; P < 0.05), wound infections (POR = 0.42; P < 0.05), length of hospital stay (WMD = -0.67; P < 0.05), and bowel obstruction episodes (POR = 0.8; P < 0.05), but an increased incidence of intra-abdominal abscess and length of operation.Conclusion: Pooled analysis demonstrates that, in children with uncomplicated acute appendicitis, LA is associated with a reduced hospital stay but broad equivalence in postoperative morbidity when compared with the conventional approach. Although overall morbidity is reduced when the laparoscopic approach is utilized, in cases of CA, the risk of intra-abdominal abscess is increased. [ABSTRACT FROM AUTHOR]

Risk management is an approach that has been used for many years in areas of business and government such as finance and insurance, but its use in the regulation of medicines has until recently been limited to tools such as the prescription status of a medicine (prescription-only or over-the-counter), the information provided to health-care professionals and patients, and the collection and evaluation of postmarketing safety reports. [ABSTRACT FROM AUTHOR]

The article presents several abstracts which were presented at the 11th meeting of the European Venous Forum, which was held on June 24-26, 2010 in Antwerp, Belgium, including abstracts on post-thrombotic vein wall remodeling, the Caprini risk assessment model in plastic and reconstructive surgery patients and delayed secondary procedures following endovenous ablation.

Background: Since November 2005, an EU Risk Management Plan (EU-RMP) has had to be submitted as part of a marketing application for all new chemical entities in the EU. In the EU-RMP, the safety profile of the medicine has to be described and pharmacovigilance activities should be proposed to study further safety concerns during use of the drug in the real-world setting. These activities include, for example, collection of spontaneously reported adverse events and post-authorization safety studies (PASS). Since the submission of an EU-RMP is a relatively new requirement, there is limited knowledge on the quality and completeness of the study protocols of PASS at the time of approval and there are no data on the influence of certain drug characteristics on the proposed pharmacovigilance activities.Objective: To examine the types of proposed pharmacovigilance activities in a sample of EU-RMPs, describe and evaluate the methodology of PASS, identify problems and propose remedies, and compare characteristics between biologicals and small molecules.Methods: Eighteen EU-RMPs (nine for biologicals, nine for small molecules) given a positive decision regarding the marketing application by the Committee for Medicinal Products for Human Use between November 2005 and May 2007 were included in this descriptive cohort study. The EU-RMPs were selected over time and different therapeutic areas. Classification of the safety concerns ('important identified risks', 'important potential risks', 'important missing information' within the EU-RMP was studied. For PASS, data source (registry, population-based database, sponsor-owned clinical trial database), source of study population to be included in PASS and comprehensiveness of study protocol (full protocol, limited protocol, study synopsis, short description, commitment without further information) were studied.Results: Compared to small molecules, safety concerns for biologicals were less frequently classified as important identified risks (relative risk [RR] 0.6; 95% CI 0.3, 1.0) and more frequently as important missing information (RR 1.6; 95% CI 1.0, 2.7). Forty-seven PASS were proposed; 31 for biologicals and 16 for small molecules. Compared with studies proposed in population-based databases (4 for biologicals, 8 for small molecules), studies in registries (18 for biologicals, 4 for small molecules) were more frequently proposed for biologicals than for small molecules (RR 2.5; 95% CI 1.1, 5.7). About 60% of the proposed PASS will include EU inhabitants. No full study protocols were submitted; 26% involved a limited study protocol, 33% a study synopsis, 37% a short description and 4% a commitment without further information.Conclusion: Approximately 40% of the study proposals for PASS were classified as a short description or a commitment to perform a study without further information, precluding an adequate scientific assessment. Studying non-EU populations may give rise to difficulties with generalizability of the results to the EU due to differences in patient characteristics, differences in the indication for the medicine and different healthcare systems. This study emphasizes the need for more complete study proposals to be submitted earlier on in the evaluation period and for the inclusion of EU inhabitants in PASS. In addition, differences in the characteristics between biologicals and small molecules, e.g. in the data source proposed, support the need for individualized tailored PASS depending on the type of drug. [ABSTRACT FROM AUTHOR]

The investment casting technique has advantages in the production of quality components and key benefits of accuracy, versatility and integrity. The mechanical performance of the ceramic shell is fundamental to the quality of the finished component. Two main techniques are used in the casting industry for the application of stucco material: rainfall sanding and fluidised bed. Work was carried out to characterise the fundamental difference in physical structure and mechanical properties of shells produced by both techniques. Stucco application within samples prepared by fluidised bed showed a tendency for the particles to be parallel to the ceramic surface, while in samples prepared by rainfall sanding the particles were more random and embedded into the slurry layer resulting in a thinner total shell build. Stress–strain curves generated form fired samples prepared by fluidised bed demonstrated a certain degree of non-brittle fracture, where this is not the case for rainfall sanding produced material. It is suggested that this is related to the manner in which cracks propagate through in the fluidised bed structure during testing. A relatively larger proportion of through stucco fracture was found in rainfall sanding produced samples in comparison to that in fluidised bed produced samples. [ABSTRACT FROM AUTHOR]

The launch of the £80m Preventative Technology Grant in 2006 has resulted in a considerable interest in telecare. Yet where in this emerging area should efforts be concentrated, and what lessons can be learnt from previous trials to aid future deployments? Based on practical experience and the work of the Housing & Telecare Learning & Improvement Networks at the Care Service Improvement Partnership (CSIP), Department of Health, this paper presents some of the common issues experienced and identified when implementing telecare. It makes a number of useful suggestions on how organisations working across housing, health and social care can make best use of telecare when planning, commissioning and delivering services. [ABSTRACT FROM AUTHOR]

Gross circumferential fracture (GCF) is a surface defect sometimes observed during the extrusion of particulate pastes. In this study particular attention was paid to the frequency of fracture in pastes undergoing ram extrusion through dies with circular, square and rectangular slot cross section. Three methods for estimating the fracture frequency were employed. The first was determined from the observed fracture periodicity, the second was determined from the application of short time Fourier transformation (STFT) techniques to the pressure signal measured at the die plate and the third was the application of the geometrical result first reported by Domanti and Bridgwater (2000). All were found to be in agreement within experimental error where failure was observed. In some materials the fracture frequency was still observed in the frequency domain after fracture ceased in the extrudate, indicating the existence of a flow instability in the paste: if the extrudate was smooth throughout the process STFT detected no peak. Fracture was more pronounced with short dies and/or where the paste experienced high wall shear stress. Square dies were more prone to fracture than circular dies (corner effects) and the fracture spacing could be related directly to the hydraulic diameter. Rectangular slot dies were more prone to irregular fracture. It was shown that lowering the die wall friction by using Teflon-lined dies reduced the propensity of the paste to fracture for all die geometries tested. [ABSTRACT FROM AUTHOR]

Heparan sulfate proteoglycan is thought to act as primary receptor for adeno-associated virus type 2 (AAV-2). Reported coreceptors include αVβ5 integrin, fibroblast growth factor receptor 1 (FGFR-1), and hepatocyte growth factor (c-Met). The interaction of AAV type 3 (AAV-3) with possible cell membrane receptors is incompletely defined. In this study, using assays detecting competition with viral infection, virus binding inhibition assays and dot blotting, we show attachment of AAV-3 strain H to heparin, heparan sulfate, and FGFR-1. These findings provide new information on the possible receptor array used by AAV-3. [ABSTRACT FROM AUTHOR]

The bovine parvovirus (BPV) hemagglutinates human erythrocytes by binding to glycophorin A (GPA). The purpose of this study was to determine which carbohydrate on GPA binds BPV. Treatment of GPA with α2,3,-6,-8 neuraminidase eliminated binding of BPV to GPA. Beta-elimination of O-linked sialic acids on GPA eliminated binding, while removal of N-linked carbohydrates using the N-glycosidase PNGase F failed to eliminate binding. Treatment of GPA with a neuraminidase which specifically cleaved α2,3 glycosidic bonds eliminated BPV binding and, following this treatment, virus binding to GPA was restored by reconstitution of α2,3-linked neuraminic acids. These results indicated the O-linked α2,3 neuraminic acids of GPA bind BPV. [ABSTRACT FROM AUTHOR]

Demand for advanced ceramics with more complex shapes continues to grow. This in combination with the need for more reliable components has forced manufacturers to look for improvements in their current processing techniques and to adopt new processes which may be better suited to fulfil market demand. New processing concepts have emerged over the past decade on two fronts, improved casting technologies, and rapid manufacturing routes that do not require moulds. In the present paper, examples of both routes are given. Possible advantages of combining conventional and emerging methods are discussed. [ABSTRACT FROM AUTHOR]

An extrusion die was introduced in which the internal geometry of the die could be controlled through a simple computer interface to produce alumina tubes with varyingly controlled bends. The relationship between the paste rheology and the bending behaviour is addressed through a detailed analysis of the rheological flow behaviour, such as paste composition and viscosity as well as the nature of the liquid binders. It is shown that the curvature of the tube is controlled by paste composition and binder rheological properties and the degree of bend increases with increasing viscosity of the paste (the greater the solids loading the greater the curvature). [ABSTRACT FROM AUTHOR]

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Investment casting research is being carried out by the University of Birmingham, sponsored by EPSRC and a consortium of industrial companies. The programme is aimed at developing a fundamental understanding of the process, with a view to routinely producing sound, net shape castings. A key stage within the investment process is that involving the removal of wax from the unfired ceramic shell. This important process is carried out within the confines of a sealed pressure vessel, more commonly referred to as a Boilerclave*, with external pressure gauges as the only indication of what is actually happening inside the cavity. To metaphorically 'see' inside the vessel would allow the factors controlling de-wax to be characterised and controlled. This paper contains results obtained at The University of Birmingham using a specially instrumented steam autoclave that allows visual data capture, thermal and steam pressure profiles within the chamber, and thermal instrumentation of waxes and shells to be obtained. Results of thermal and pressure profiles inside the vessel body are presented and implications of these results upon the mechanism of wax removal and the effect upon ceramic shells are discussed. [ABSTRACT FROM AUTHOR]

Investment casting research is being carried out by the University of Birmingham, sponsored by EPSRC and a consortium of industrial companies. The programme is aimed at developing a fundamental understanding of the process, with a view to routinely producing sound, net shape castings. A key stage within the investment process is that involving the removal of wax from the unfired ceramic shell. This important process is carried out within the confines of a sealed pressure vessel, more commonly referred to as a Boilerclave*, with external pressure gauges as the only indication of what is actually happening inside the cavity. The de-wax stage is a key stage in the process as wax needs to be removed from a weak ceramic shell system without cracking or dimensional alterations, which would be reflected in out of tolerance casting scrap. Due to the nature of the process, wax removal is probably the least understood or controlled aspect of the whole investment sequence. The following paper is the second of two which contain results obtained at The University of Birmingham using a specially instrumented stream autoclave which allows visual data capture, thermal and steam pressure profiles within the chamber, and thermal instrumentation of waxes and shells to be obtained. Results of thermal and pressure profiles within individual wax components are presented and implications of these results upon the mechanism of wax removal and the effect upon ceramic shells are discussed. [ABSTRACT FROM AUTHOR]

Investment casting research is being carried out by the University of Birmingham, sponsored by EPSRC and a consortium of industrial companies. The programme is aimed at developing a fundamental understanding of the process, with a view to routinely producing sound, net shape castings. A key stage within the investment process is that involving the removal of wax from the unfired ceramic shell. This important process is carried out within the confines of a sealed pressure vessel, more commonly referred to as a Boilerclave (trademark, Leeds and Bradford Boiler Co. Ltd, UK) with external pressure gauges as the only indication of what is actually happening inside the cavity. The dewaxstage is a key stage in the process as wax needs to be removed from a weakceramic shell system without cracking or dimensional alteration, which would be reflected in outoftolerance casting scrap. Owing to the nature of the process, wax removal is probably the least understood or controlled aspect of the whole investment sequence. The following paper is the third in a series which contain results obtained at the University of Birmingham using a specially instrumented stream autoclave which allows visual data capture, thermal and steam pressure profiles within the chamber and thermal instrumentation of waxes and shells to be obtained. The results of simple conductivity calculations and experimentation to determine the effect of moisture upon the strength of ceramic shells will be presented and the strengthening role of wax penetration into the primary coat of the ceramic shell during dewax will be investigated. [ABSTRACT FROM AUTHOR]

Models for the strain energy release rate in crack extension and tunnelling are taken from the literature with minor modification to take account of the compressive stresses in multi-layer ceramic tubes or composites. These models are applied to predict the potential for crack development in co-extruded tubes fabricated from combinations of alumina, zirconia (fully and partially stabilized) and zirconia toughened alumina. Experimental results show that the models predict the failure in the composites closely and thus form useful tools in the design of such structures. The main aspect of the predictive capacity is in the selection of the layer numbers and the layer thicknesses to prevent failure. The significance of crack-free layers is improved mechanical properties, in particular strength, and potential improvement in fracture toughness and device performance. [ABSTRACT FROM AUTHOR]

Objective: Continuous i.v. epoprostenol (prostacyclin) therapy improves survival and quality of life in patients with pulmonary arterial hypertension (PAH). i.v. epoprostenol therapy may be limited by serious complications related to the need for an implanted central venous catheter, and its chemical instability and short half-life. Treprostinil is a longer-acting prostacyclin analog, chemically stable, and suitable for continuous subcutaneous administration. We report successful transitioning to subcutaneous treprostinil of patients who presented with life-threatening complications of i.v. epoprostenol delivery.Design: Open, uncontrolled study.Setting: ICUs and departments of cardiology at academic hospitals.Patients: Eight patients with PAH treated with continuous i.v. epoprostenol.Intervention: Transition to subcutaneous treprostinil following an empiric protocol.Results: Transition to treprostinil was achieved successfully in 21 to 96 h, with no major adverse side effects, and no change in the improved clinical status achieved with i.v. epoprostenol. Doses of epoprostenol before transition ranged from 3.5 to 75 ng/kg/min (mean, 27 ng/kg/min). Doses of treprostinil at completion of the transition ranged from 3 to 65 ng/kg/min (mean, 22 ng/kg/min). Four to 11 months later, the patients remained clinically improved. In spite of mild-to-moderate infusion site pain, all patients reported an improved sense of comfort and well-being.Conclusion: Patients with PAH can be safely transitioned from treatment with i.v. epoprostenol to subcutaneous treprostinil. [ABSTRACT FROM AUTHOR]

Presents a study which assessed the feasibility of using the ring-loaded strength test in mineral applications and the relationship of the ring-loaded strength with tests associated with comminution circuit design and fracture testing. Review of related literature; Methodology; Results and discussion.

The Huon estuary, in southeastern Tasmania, is an important location for finfish, and to a lesser extent shellfish, farming. The Huon catchment is a lightly populated rural and forested region in a cold temperate climate which supports agriculture (horticulture and livestock), forestry, and tourism. The estuary (40 km in length) is microtidal, with a stratified to partially mixed water column. Effective design of sampling procedures for either monitoring or interdisciplinary studies is essential for resolution of the key time and space scales, and the operational programme must be relevant for events and processes in both the water column and the sediments. We chose to track seasonal changes in physical, chemical, and biological parameters by doing quarterly samplings of the water column at a grid of stations (63 in all) that encompassed the entire estuary from a freshwater end-member to a designated marine boundary. More rapid events were captured by monitoring (both autonomous instrument systems and manual sampling), at hourly to weekly intervals, at a small representative subset of the estuarine stations. Underway measurements from the research vessel were used to map transient surface and near-surface features. Sediments are long-term integrators of processes in the water column and therefore an intensive spatial survey of the sediment characteristics has been made to characterize the long-term influence of human activities. Knowledge gained from field observations of the baseline study has been used to outline an autonomous monitoring network that will derive the environmental information critical for the prudent management of the waterway for both its natural and commercial values. [ABSTRACT FROM PUBLISHER]

Analyzes the combinatorial properties of Cayley graphs of finite group. Node bisectors of the graphs; Subset of the nodes; Cayley graph of an abelian group.

Paralytic shellfish toxin profiles of the dinoflagellate Gymnodinium catenatum Graham were investigated as a possible biochemical marker to distinguish different geographic populations of this species. Isolates obtained between 1986 and 1988 from Japan, Tasmania (Australia) and Galicia (Spain) were cultured under similar conditions and the toxins produced were analyzed using HPLC. Variations in temperature, salinity, and nitrate and phosphate levels in the culture medium had no significant effect on the toxin profile, suggesting that toxins can be used as a stable biochemical marker for this dinoflagellate. All the isolates produced mainly toxins of the N-sulfocarbamoyl group (C1-C4, gonyautoxins 5 and 6) but their relative abundance differed according to their geographic origin. Furthermore, only the Australian population produced the newly found 13-deoxydecarbamoyl toxins, and these could readily be used to distinguish the Australian populations from those of the other two countries. [ABSTRACT FROM AUTHOR]